1518058049 NPI number — PANHANDLE MEDICINE OF INWOOD, PLLC

Table of content: (NPI 1518058049)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518058049 NPI number — PANHANDLE MEDICINE OF INWOOD, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PANHANDLE MEDICINE OF INWOOD, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518058049
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1845
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INWOOD
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25428-1845
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-229-7630
Provider Business Mailing Address Fax Number:
304-229-7689

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
365 MIDDLEWAY PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INWOOD
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25428-1845
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-229-7630
Provider Business Practice Location Address Fax Number:
304-229-7689
Provider Enumeration Date:
09/28/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VELTMAN
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
COLLETT
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
304-229-7630

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  54825 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)